Individual
BRADLEY TRENT CLAIR
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
5196 HILL RD E, STE 202, LAKEPORT, CA 95453-6360
(707) 263-1777
(707) 263-8137
Mailing address
3536 MENDOCINO AVE, STE 200, SANTA ROSA, CA 95403-3634
(707) 575-6049
(707) 263-8137
Taxonomy
Speciality
Code
Description
License number
State
207RC0000X
Cardiovascular Disease Physician
Primary
A45681
CA
207RI0011X
Interventional Cardiology Physician
A45681
CA
207UN0901X
Nuclear Cardiology Physician
A45681
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00A456810
BLUE SHIELD OF CALIFORNIA
CA
05
—
00A456810
—
CA
01
—
060020642
RAILROAD MEDICARE
CA
Enumeration date
07/05/2005
Last updated
02/07/2012
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